Lessons Learned When Grandmother is the LC
A note on inclusivity: This post is written from the perspective of the author’s personal experiences and thus, at times, uses gendered language. However, the core messages are intended to be applicable to people of all genders. We aim to amplify content that is as inclusive as possible, and USLCA recognizes that not everyone’s experiences will mirror the author’s.
By: Nikki Lee, RN, BSN, MS, IBCLC, ANLC, CIMI, RYT500
After thousands of dollars, and years of infertility, these first-time parents, both in their late 40s and accomplished in their careers, welcomed their baby girl. She arrived with a gestational age of 41+ 5-days, after a 2-day induction (Foley-balloon, 4 doses of misoprostol, 2 doses of fentanyl, IV synthetic oxytocin, and an epidural). Their amazing doula supported them throughout, and, after an hour of pushing, the healthy baby was caught by the midwife.
The Father texted updates throughout the labor, increasing Grandmother’s anxiety. While waiting, Grandmother cleaned the parents’ house and did all their laundry as useful ways to cope with her own anxiety. She felt connected to all the grandmothers throughout time who prayed for their daughter’s safe delivery.
The Mother refused offers from nursing staff to “help to latch the baby on.” She thanked them, said, “I got this,” kept her baby skin to skin and was breastfeeding within 30 minutes of the birth. (Growing up with a mother who taught childbirth classes and had a private lactation consulting practice had its benefits!)
After 26 hours in the hospital, the new family came home to a clean house and freshly laundered sheets. Grandmother welcomed them and offered food and suggestions. In response, the parents fled to their bedroom with their new baby and shut the door in the Grandmother’s face.
Lesson One: It’s THEIR baby. (Thank you, Linda Smith.)
Over the next week, Mother and Baby worked together to learn breastfeeding. Grandmother waited on them, encouraged the new mother, offered helpful hints, and continually monitored diaper contents.
Please, dear reader, take a moment and think about all the possible challenges to breastfeeding and lactation for this dyad. There probably isn’t a single one that Grandmother, who has worked with breastfeeding families since the late 1970s, didn’t worry about.
The first place Grandmother looked when meeting her granddaughter for the first time was at Baby’s tongue; only after assessing tongue extension and mobility, did then she give a sigh of relief and look at Baby’s face.
During the first few weeks, anxiety and fear were part of the family. The biggest challenge for any new mother is to keep the baby alive1. (How many readers remember checking their newborn’s breathing every 5 minutes?) This Mother was no different, with concerns and questions about everything. The Father worried about supporting his new family; Grandmother worried about every possible breastfeeding and infant problem. All the adults were concerned about breastfeeding, jaundice, weight gain, pees and poos.
Lesson Two: Everybody worries when there is a newborn in the house. No one can relax until there is proof that the baby is growing.
The Baby stayed in constant skin-to-skin contact with her mother most of the time, including breastsleeping. Fortunately, it was summer, so the Mother could be outside in a walled garden. This enabled her to manage her much larger breasts in privacy. By day 4, she could breastfeed standing up, and was skilled at ambulatory breastfeeding.
Lesson Three: continuous skin to skin works to establish breastfeeding even after induction and labor medications.
Lennart Righard and Margaret Alade were right about this, in their 1990 article about delivery room routines.2 It was thrilling to see research findings validated.
Baby became jaundiced, with a bilirubin level of 13 at the Day 3 pediatric visit. The pediatrician said, “Oh, you’re breastfeeding” and made no recommendations. Grandmother started giving Baby twice-daily naked sunbaths, for 5 minutes each session. She felt like she wanted to die when, during a walk outside, the surprisingly fierce summer sun burned a pink spot on the baby’s forearm. Immediate application of fresh aloe vera gel worked, and the area healed within a day.
This is what nursing looked like on Day 3:
After seeing this photograph, the Grandmother reminded her daughter to bring Baby’s chin to touch the breast, and aim for a deeper latch. Baby’s output was always plentiful, with a diaper blowout dripping onto the kitchen floor on Day 4. While the jaundice in her chest and shoulders and back cleared in the second week, Baby’s sclera didn’t turn white until the third week.
This Lactation Consultant has taught for decades that babies don’t pretend to be well to make their parents feel better. Living those words was scary. Baby peeing and pooping plenty? Check. Baby alert and responsive? Check. Baby smiling once in a while, after a feed? Check. Baby in constant skin-to-skin contact, breastfeeding at the earliest cues? Check. Mother without nipple damage or latch pain? Check. Mother attentive and sensitive to her baby? Check.
Then why was Grandmother so worried?
She was constantly defending her care to herself, while feeling the imagined social pressure of being a teacher in the lactation professional community. What if her grandbaby developed central nervous system issues after being jaundiced? She felt responsible for the baby’s condition. Anything wrong would be her fault. Perfectionism joined anxiety and fear.
Baby didn’t achieve a reliable perfect latch every time until the end of the first week. During that week, Baby would come off the breast and hold or suck her hands. This meant that she needed help with managing a breast that changed size, shape, and weight, both during a feed and from feed to feed. These breast changes were continual during those first weeks of calibration.
Fortunately, since the dyad were breastsleeping and together all the time, usually skin to skin, there were unlimited opportunities to learn in an atmosphere of high oxytocin levels.
Lesson Three: Reprise.
The Mother’s nipples pointed to the floor when she sat up straight. As a result, her instinct to hug her baby close, pulling her baby to her heart, made latch uncomfortable. She learned to hug mindfully by hugging her baby up towards her shoulders, instead of directly into her heart.
Baby’s pattern of feeding was to have a cluster of 5-6 feeds, followed by a 3 to 5-hour period of being in a quiet alert state, engaging with family or sleeping. Baby could breastfeed 8-12 times between dawn and lunch. This pattern held steady for nearly a year.
Lesson Four: Newborns breastfeed 6-28 times in 24 hours.
Chele Marmet (personal communication 20233 from one of the founders of the lactation consultant profession), Kent et al. (2006)4 and Kent et al. (2013)5 were right.
Here’s how to help babies breastfeed that much:
1) Provide on-going household support so the birthgiver has to do only two things: recover from giving birth, and build a breastfeeding relationship.
2) Encourage breastfeeding standing up. (Key to long breastfeeding duration.)
3) Take the birthgiver outside for fresh air and sunshine. This promotes a feeling of normalcy and relaxation. Nature is restorative.
Grandmother was concerned about the newborn’s weight. Even though Baby was nursing often, acting normally, and pooping plenty, that worry did not go away for a week. Baby’s birth weight was 5 pounds 15 ounces (2693.2 grams), and she came home 26 hours later at 5 pounds 11 ounces (2579.8 grams). Grandmother worried enough to rent a scale on Day 7. (Thank you, Melissa Cole.) The whole family gathered to see the baby weighed and gave a unanimous sigh of relief when Baby weighed 6 pounds 4 ounces (2835 grams), a total gain of 9 ounces (255.2 grams) in 6 days.
The baby’s poop didn’t turn to mustard until the beginning of the second week, another source of concern for Grandmother. She has taught for decades that the poop should turn yellow by the end of the first week. Grandmother turned to a colleague and friend (thank you, Leslie Cree) for support during this time, as she didn’t want to add her worries to the insecurity of both parents. What could be done? Baby was acting fine, nursing lots, gaining weight, peeing and pooping lots. So again, Grandmother prayed, and texted pictures of diaper contents to her friend. Finally, the mustard came in the middle of the second week.
Lesson Five: When Grandmother is providing the breastfeeding support, she needs support too.
Lesson Six: Look at the whole picture, instead of focusing on a piece of that picture.
Baby started pooping explosive foam in the second week. It wasn’t until the 23rd day that Grandmother identified an oversupply.
Lesson Seven: Families that conceive after IVF can have oversupply.
Hindsight leads to wondering if the oversupply started in the first week, when baby gained 9 ounces in 6 days.
Grandmother missed this diagnosis because she made a wrong assumption. She assumed that a long history of infertility technology would lead to a low milk supply. This assumption was magnified by her anxiety about Baby’s jaundice and weight.
Grandmother finally identified that the oversupply was the result of accidental switch nursing. Baby would be fussy, go to breast and nurse contentedly for 2 minutes. Then she’d come off and be fussy again. Mother would switch to the other side. Baby would nurse contentedly for 2 minutes, before coming off fussy again. She wanted to nurse to make her tummy feel better. Then she’d get too much milk too quickly and be unhappy. Once oversupply was identified, leaving the baby on one breast for two-hour blocks increased comfort and made the poops normal. The Mother had to maintain the block feeding until long after her baby started solids, as her unique lactation physiology would make too much milk within 24 hours when she forgot.
When Baby was about 2 months old, Grandmother realized that she’d been so focused on the dyad that she hadn’t given enough attention to the Father. She spent some time with him describing all the wonderful things he was doing to connect with his baby and support his wife. She told the Father about all the wonderful things that he was doing, how his baby loves when he dances with and sings to her, and how well he is doing as a responsive parent.
Lesson Eight: Remember that the other parent(s) in the household need encouragement and recognition.
Despite the live-in advice and encouragement, Mother hired an IBCLC for some home visits, paid for by insurance. Her baby was fussy, and she herself was anxious overwhelmed. Having a different voice, one of the Mother’s own generation, was helpful.
Lesson Nine: Be grateful when the family seeks breastfeeding help.
Watch and learn. (Make no comment when the IBCLC recommends the same things that the Grandmother had already suggested.)
Granddaughter is nearly two years old now, growing, still nursing and developing new skills. The Mother still gets weepy when she thinks of the too-many mothers and parents in the US today who don’t have the essential support that she had.
References:
- Stern, D. The Birth of a Mother Basic Books; 1st edition (December 3, 1998)
- Righard L, Alade MO. Effect of delivery room routines on success of first breast-feed. Lancet. 1990 Nov 3;336(8723):1105-7. doi: 10.1016/0140-6736(90)92579-7. PMID: 1977988.
- Chele Marmet, BS, MA, IBCLC (Ret.), FILCA. Personal communication April 2023.
- Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006 Mar;117(3):e387-95. doi: 10.1542/peds.2005-1417. PMID: 16510619
- Kent JC, Hepworth AR, Langton DB, Hartmann PE. Impact of Measuring Milk Production by Test Weighing on Breastfeeding Confidence in Mothers of Term Infants. Breastfeed Med. 2015 Jul-Aug;10(6):318-25. doi: 10.1089/bfm.2015.0025. Epub 2015 Jun 19. PMID: 26090790.
About the Author: Nikki is a nurse, a childbirth educator, a lactation consultant, an infant massage instructor, a cranio-sacral therapist, a researcher, an author, a public speaker. and a registered yoga teacher. At present, she maintains a private practice as a holistic consultant (with a wide range of services offered), and teaches infant massage and TummyTime! classes. She. offers a 20 nursing contact hour, 20-CERP Basic Breastfeeding course nationally. on Zoom. Other interests include back-up rhythm guitar (Cajun and old-time), hiking, yoga, and Integrated positional therapy. Nikki happily offers her services on a sliding scale to every family and lactating person. She proudly endorses the WHO Code of Marketing of Breastmilk Substitutes, and has no affiliation nor sponsorship from any corporation or organization. Nikki imagines clean air, clean water and fresh wholesome food being major international goals. She imagines that the pursuit of armaments and war is dropped, because it isn’t good for babies. She sees everyone, everywhere, caring for and about babies.
